Case Report J Cardiol & Cardiovasc Ther Volume 11 Issue 4 - August 2018 Copyright © All rights are reserved by Basumatary LJ DOI: 10.19080/JOCCT.2018.11.555816 Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in ImmunocompetentPatient- A Case Report

Basumatary LJ1* and Lalit MB2 1Consultant Neurologist, Downtown Hospitals, India 2Department of Neurology, Downtown Hospitals, India Submission: May 10, 2018; Published: August 06, 2018 *Corresponding author: Basumatary LJ, Consultant Neurologist, Downtown Hospitals, India, Email:

Abstract Herpes zoster is caused by reactivation of the latent varicella zoster virus which is present due to an earlier varicella infection. The

prodromal stage, the only presenting symptom may be odontalgia, which may prove to be a diagnostic challenge, since many diseases can cause simultaneous occurrence of herpes zoster and varicella zoster in the same patient is sufficiently uncommon to warrant notice. During the division of right trigeminal nerve masquerading as odontalgia with simultaneous occurrence of varicella zoster and right facial nerve palsy. or facial pain, and the diagnosis must be properly established before final treatment. Here we present a case of herpes zoster involving the second Keywords: Herpes zoster; Chicken-pox; Varicella zoster virus; Simultaneous occurrence of chicken pox and herpes zoster; Odontalgia

Introduction Herpes Zoster (HZ) occurs as a reactivation of Varicella Zoster Case Report Virus (VZV) that remains latent in dorsal sensory nerve root 48 year old male non diabetic non hypertensive developed ganglion after primary varicella infection (chicken-pox). Bokay papulo-vesicular rashes over right side of face, toothache and fever. He approached to a local dentist and was advised to take co- & HZ. Since his observation, many such cases have appeared in amoxiclav and analgesics. As there was no improvement moreover [1] was the first to note the association of Varicella Zoster (VZ) the medical press in which varicella had developed in susceptible rashes spread along the right maxillary nerves (V2) and the right individuals when exposed to HZ and vice versa. Ferryman [2] half of the palate, he presented to us and admitted on the 5th day reviewed about 100 cases, and concluded that this combination of rashes. Lesions were painful, burning in nature, non-pruritic of diseases was common in the elderly men; and that varicella and associated with watering & redness of right eye. Typical chicken-pox lesions were also present all over the torso and both the literature to date, and described three cases. He stated that upper limbs, sparsely over lower limbs. He had no past history followed herpes zoster within five days. Campbell [3] reviewed in all his cases an attack of unilateral HZ was followed by the of chickenpox; his sister-in-law (1st level contact) also developed chicken pox after a few days. He developed right sided peripheral facial nerve palsy during the course of the disease. Other cranial development of a varicella rash at interval of five to seven days. by VZ. Sukhala [5] also reported such unusual case of simultaneous nerve examination was found normal. There were no vesicles John Almeyda [4] also reported 3 such cases in which HZ followed occurrence of HZ ophthalmic us involving the ophthalmic and or other form of eruption in the auricular zone. The tympanic maxillary division of trigeminal nerve followed two days later by membrane, external auditory canal and meatus, concha, tragus, the generalized chicken pox. Chava [6], published a case series antitragus, helix and fossa, and posterior surface of the lobe of the in which he described HZ may arise as precede to VZ as in the ear were entirely normal. There was no earache throughout the case of 85 year old male patient, who never had varicella or zoster course of the illness. developed HZ of all three trigeminal branches of left side with Clinical examination superinfection of staph aurous and proteus species and typical varicella rash with lesions on the buccal mucosa and fauces. Febrile (temp 102.6 °F), Pulse-92bpm, BP-120/90mm of Hg, no P/I/C/Cy/O, S/E- NAD.

J Cardiol & Cardiovasc Ther 11(4): JOCCT.MS.ID.555816 (2018) 001 Journal of Cardiology & Cardiovascular Therapy

Investigation varicella rash all over the body in immune competent patient is extremely uncommon and to my knowledge not yet reported. Conclusion RBS-116mg/dl, s. Na₊-132.6mEq/L, s. K₊ 4.72mEq/L, Hb- 1/2 non-reactive, Liver function test-within normal limits, swab 12.3gm%, TC-6000/cu mm, P-63, L-25, M-10, E-02, ESR-15, HIV- In conclusion, a case of HZ affecting the second division of from right side face lesions- staphylococcus aureus. Tzank smear the trigeminal nerve is reported along with facial nerve palsy and from vesicles found to be positive. Varicella- Zoster IgG antibody simultaneous occurrence of chicken-pox in immune competent was positive and IgM was negative sent on 10th day of fever. patient. This case highlights the importance of a thorough dental Diagnosis and treatment history and examination in patients with odontalgia. Those cases presenting with atypical odontalgia, HZ should be considered in the differential diagnosis. Furthermore, clinicians should be aware laboratory reports as the simultaneous occurrence of HZ of second Diagnosis was made on the basis of history, clinical profile and of atypical presentation of VZV. Clinicians are urged to recognize division of trigeminal nerve & VZ with superadded secondary the early features of HZ and to provide prompt antiviral therapy to infection of staphylococcus aureus and peripheral facial nerve prevent the complications. palsy. He was managed over tab valcyclovir, tab gabapentin, IV ceftriaxone, acyclovir ointment for both eye and skin lesions. References He improved satisfactorily and then discharged. On subsequent 1. Bokay V (1892) Quoted by John Alymeda (1942) Post Graduate Medical follow up his skin lesions healed by crusting, but painful sensation and paresthesia over right maxillary nerve distribution persisted. 2. Journal 18(203): 175-177. On subsequent follow-up facial palsy improved completely. Ferriman DG (1939) Multidermatomal herpes zoster in an Discussion immunocompromised patient-A case report. Lancet 1: 930. 4. Almeyda J (1942) Simultaneous occurrence of herpes zoster and The majority of HZ infections involve the thoracic and 3. Campbell RM (1941) Brit J Child Dis 38: 91-98.

5. present with infections involving any of the three branches of varicella. Postgrad Med J 18(203): 175-177. lumbar dermatomes; however, approximately 13% of patients followed by varicella in a young adult. Indian Journal of Ophthalmol the trigeminal nerve. The ophthalmic branch is most commonly Shukla IM, Tiwari SK, Billore OP (1973) Herpes zoster ophthalmic us affected; however, in our case only the maxillary branch is 6. 21(3): 131-133. nerve palsy with trigeminal nerve HZ is even rarer, one such case Chava ER (1961) Complications of chicken-pox. Br Med J 1(5230): 944- involved; this is rare (1.7% of cases) [7]. Occurrence of the facial 947. reported by John D Spillane. But the simultaneous occurrence Population based study of herpes zoster and its sequelae. Medicine of the facial nerve palsy after maxillary nerve HZ with a typical 7. (Baltimore)Ragozziuo MW, Melton LJ, Kudand LT, Chu CP, Perry HO (1982)

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How to cite this article: Basumatary LJ, Lalit MB. Simultaneous Occurrence of Chicken Pox and Herpes Zoster with Facial Nerve Palsy in ImmunocompetentPatient- 002 A Case Report. J Cardiol & Cardiovasc Ther. 2018; 11(4): 555816. DOI: 10.19080/JOCCT.2018.11.555816